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- HSIL ?
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本帖最后由 于 2009-01-09 06:42:00 编辑
| 以下是引用mingfuyu在2009-1-8 7:40:00的发言： The recommendation for ASC-H is directly colposcopy, no HPV will be done. |
Dr. Yu: You are right based on ASCCP guidline. My recent paper including others indicates HPV tedsting is very usful for risk assessment for ASC-H. We did reflex HPV testing for almost all ASC-H cases (physicians choose), the same as in many other institutes.
Occasinally the clinicians pick to order HPV testing for ASC-US, but not for ASC-H. In this situation I may pick ascus to get hpv testing done even though the cells look like asc-h. If hpv is positive I cannot change back to asc-h, but I will write a comment to mention that some atypical cells with increased n/c ratio, dark nuclei et al. Colposcopy is strongly suggested to rule out HSIL. In our institute, reflaxing hpv testing have not routinely ordered by clinicians for AGC, even we try hard to introduce to the clinicians. For a lot of ?AGC cases (but cytotech called AGC already), I call them as ascus to have hpv testing. I will think over if I will add AGC diagnosis to this case when I know the hpv testing result. For many cases I feel the cytology features are not good enough to call agc, plus negative hpv, especially for young women. I just call these cases ascus with Pap f/u.
We may treat each case individually. Just for your reference.
My asc-h paper:
Adjunctive human papillomavirus DNA testing is a useful option in some clinical settings for disease risk assessment and triage of females with ASC-H Papanicolaou test results.
Bandyopadhyay S, Austin RM, Dabbs D, Zhao C.
Arch Pathol Lab Med. 2008 Dec;132(12):1874-81.
ASC, metaplastic type. In my practice, most ASC will trigger high righ HPV test which has very strong predictive value.
Please do not call this HSIL because HSIL is a very significant diagnosis. The chromatin is fine, not coarse; nuclear membrane very smooth, not irregular; nuclei kind of pale, not dark. I would call this ASC because some nuclei are enlarged with uneven chromatin distribution and some nuclei are kind of piled up. It is metaplastic type because N/C ratio is high and some area even shows residual glandular architecture. Atypical metaplatic cells mimic HSIL, sometimes they are ASC, other times ASC-H, still other times, they are true HSIL.
When I am not sure it is ASC or AGC, i would call it ASC to get HPV test. When i call AGC, no HPV is done and GYN docs do colposcopy directly.
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I feel reluctant to call this case negative even though it can be a true negative case finely. I favor to call ASC-H. Also there are some features of AGC. HR HPV testing result can help to assess the risk of the women. Patient's clinical history, previous Pap test or HPV testing results may also be helpful.
